[Translated article] Less superior adjacent syndrome and lower reoperation rate. Medium- and long-term results of cervical arthroplasty versus anterior cervical arthrodesis: Systematic review and meta-analysis of randomized clinical trials

• Published in: Revista española de cirugía ortopédica y traumatología Vol. 68; no. 2; pp. T168 - T178
• Main Authors: Núñez, J.H., Escudero, B., Montenegro, J.D., Jiménez-Jiménez, M.J., Martínez-Peña, J., Surroca, M., Bosch-García, D.
• Format: Journal Article
• Language: English
• Published: Spain Elsevier España, S.L.U 01.03.2024; Elsevier
• Subjects: Arthrodesis; Arthroplasty; Artrodesis; Artroplastia; Cervical; Columna vertebral; Meta-analysis; Metaanálisis; Resultados; Results; Spine; Metaanálisis; Columna vertebral; Artrodesis; Spine; Results; Resultados; Cervical; Arthrodesis; Artroplastia; Arthroplasty; Meta-analysis
• ISSN: 1888-4415; 1988-8856
• DOI: 10.1016/j.recot.2023.11.013

To compare medium- and long-term postoperative surgical results, especially the adjacent syndrome rate, adverse event rate, and reoperation rate, of patients operated on with cervical arthroplasty or anterior cervical arthrodesis in published randomized clinical trials (RCTs), at one cervical level. Systematic review and meta-analysis. Thirteen RCTs were selected. The clinical, radiological and surgical results were analyzed, taking the adjacent syndrome rate and the reoperation rate as the primary objective of the study. Two thousand nine hundred and sixty three patients were analyzed. The cervical arthroplasty group showed a lower rate of superior adjacent syndrome (P<0.001), lower reoperation rate (P<0.001), less radicular pain (P=0.002), and a better score of neck disability index (P=0.02) and SF-36 physical component (P=0.01). No significant differences were found in the lower adjacent syndrome rate, adverse event rate, neck pain scale, or SF-36 mental component. A range of motion of 7.91° was also found at final follow-up, and a heterotopic ossification rate of 9.67% in patients with cervical arthroplasty. In the medium and long-term follow-up, cervical arthroplasty showed a lower rate of superior adjacent syndrome and a lower rate of reoperation. No statistically significant differences were found in the rate of inferior adjacent syndrome or in the rate of adverse events. Comparar a mediano y a largo plazo los resultados quirúrgicos postoperatorios, sobre todo la tasa del síndrome adyacente, la tasa de eventos adversos y la tasa de reoperación, de los pacientes operados con artroplastia cervical o artrodesis cervical anterior en los ensayos clínicos aleatorizados (ECA) publicados de un nivel cervical. Revisión sistemática y metaanálisis. Se seleccionaron 13 ECA. Se analizaron los resultados clínicos, radiológicos y quirúrgicos, tomando como variables primarias la tasa del síndrome adyacente, la tasa de eventos adversos y la tasa de reoperación. Fueron 2.963 los pacientes analizados. El grupo de artroplastia cervical mostró una menor tasa de síndrome adyacente superior (p<0,001), una menor tasa de reoperación (p<0,001), un menor dolor radicular (p=0,002) y una mejor puntuación en el índice de discapacidad cervical (p=0,02) y en el componente físico SF-36 (p=0,01). No se encontraron diferencias significativas en la tasa del síndrome adyacente inferior, en la tasa de eventos adversos, en el dolor cervical ni en el componente mental SF-36. En la artroplastia cervical se halló un rango de movilidad medio de 7,91 grados en el seguimiento final y una tasa de osificación heterotópica del 9,67%. En el seguimiento a mediano y a largo plazo, la artroplastia cervical mostró una menor tasa de síndrome adyacente superior y una menor tasa de reintervención. No se hallaron diferencias estadísticamente significativas en la tasa del síndrome adyacente inferior ni en la tasa de eventos adversos.